Journal of PeriAnesthesia Nursing
Volume 24, Issue 1 , Pages 19-34 , February 2009

Scientific Advances in the Genetic Understanding and Diagnosis of Malignant Hyperthermia

References 

  1. Malignant Hyperthermia Association of the United States. What is malignant hyperthermia? Available at: http://www.mhaus.org/index.cfm/fuseaction/OnlineBrochures.Display/BrochurePK/8AABF3FB-13B0-430F-BE20FB32516B02D6.cfm. Accessed April 6, 2007.
  2. Malignant Hyperthermia Association of the United States. Home page. Available at: http://medical.mhaus.org. Accessed March 5, 2008.
  3. Association of periOperative Registered Nurses . Malignant hyperthermia (MH) guideline. In Perioperative Standards and Recommended Practices. Denver: AORN Inc; 2008;103-125
  4. Noble K. Malignant hyperthermia: Hot stuff. J Perianesth Nurs. 2007;22:341–345
  5. Denborough M, Lovell R. Anaesthetic deaths in a family. Lancet. 1960;2:45
  6. Denborough M, Forster J, Lovell R, et al. Anaesthetic deaths in a family. Br J Anaesth. 1962;34:395–396
  7. Jones E, Nelson T, Anderson M, et al. Malignant hyperthermia of swine. Anesthesiology. 1972;36:42–51
  8. Gronert G, Milde J, Theye R. Dantrolene in porcine malignant hyperthermia. Anesthesiology. 1976;44:488–495
  9. Mickelson J, Gallant E, Litterert L, et al. Abnormal sarcoplasmic reticulum ryanodine receptor in malignant hyperthermia. J Biol Chem. 1988;263:9310–9315
  10. Neuman B, Fawcett J. The Neuman Systems Model. 4th ed. Upper Saddle River, NJ: Prentice Hall; 2002;
  11. Mathieu A, Bogosian A, Ryan J, et al. Recrudescence after survival of an initial episode of malignant hyperthermia. Anesthesiology. 1979;51:454–455
  12. Strazis K, Fox A. Malignant hyperthermia: A review of published cases. Anesth Analg. 1993;77:297–304
  13. Rosenberg H, Davis M, James D, et al. Malignant hyperthermia. Orpha (November 2004). Available at: http://www.orpha.net/data/patho/GB/uk-malignant-hyperthermia.pdf. Accessed April 5, 2007.
  14. Tobin J, Jason D, Challa V, et al. Malignant hyperthermia and apparent heat stroke. JAMA. 2001;286:168–169
  15. Pollock N, Hodges M, Sendall J. Prolonged malignant hyperthermia in the absence of triggering agents. Anaesth Intensive Care. 1992;20:520–523
  16. Lichtman A, Oribabor C. Malignant hyperthermia following systemic rewarming after hypothermic cardiopulmonary bypass. Anesth Analg. 2006;102:372–375
  17. Katz J, Krich L. Acute febrile reaction complicating spinal anaesthesia in a survivor of malignant hyperthermia. Can Anaesth Soc J. 1976;23:285–289
  18. Karan S, Crowl F, Muldoon S. Malignant hyperthermia masked by capnographic monitoring. Anesth Analg. 1994;78:590–592
  19. Sprung J, DeBoer G, Zanettin G, et al. Intraoperative hyperkalemia as a triggering mechanism or presenting sign of malignant hyperthermia in two patients with chronic renal failure. Anesthesiology. 1995;82:1518–1522
  20. Struebing V. Differential diagnosis of malignant hyperthermia: A case report. J Am Assoc Nurs Anesth. 1995;63:455–460
  21. Michalek-Sauberer A, Fricker R, Gradwohl I, et al. A case of suspected malignant hyperthermia during desflurane administration. Anesth Analg. 1997;85:461–462
  22. Short J, Cooper C. Suspected recurrence of malignant hyperthermia after post-extubation shivering in the intensive care unit, 18 h after tonsillectomy. Br J Anaesth. 1999;82:945–947
  23. Kleopa K, Rosenberg H, Heiman-Patterson T. Malignant hyperthermia-like episode in Becker muscular dystrophy. Anesthesiology. 2000;93:1535–1537
  24. Hoenemann C, Halen-Holtgraeve T, Booke M, et al. Delayed onset of malignant hyperthermia in desflurane anesthesia. Anesth Analg. 2003;96:165–167
  25. Christinasen L, Collins K. Pathologic findings in malignant hyperthermia: A case report and review of literature. Am J Forens Med Pathol. 2004;25:327–333
  26. Papadimos T, Almasri M, Pagett J, et al. A suspected case of delayed onset malignant hyperthermia with desflurane anesthesia. Anesth Analg. 2004;98:548–549
  27. Fernandez C, Azevedo D, Bomes J, et al. Malignant hyperthermia in a liver transplant patient: A case report. Transplant Proc. 2007;39:3530–3532
  28. Bonciu M, de la Chapelle A, Delpech H, et al. Case report: Minor increase of endtidal CO2 during sevoflurane-induced malignant hyperthermia. Paediatr Anaesth. 2007;17:180–182
  29. Miller R. In: Miller's Anesthesia, vol. 1. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005;
  30. Mozley P. Malignant hyperthermia following intravenous iodinated contrast media. Diagn Gynecol Obstet. 1981;3:81–86
  31. Wappler F, Roewer N, Kochling A, et al. Fulminant malignant hyperthermia associated with ketoacidotic diabetic coma. Intensive Care Med. 1996;22:809–812
  32. Larach M, Localio A, Allen G, et al. A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology. 1994;80:771–779
  33. Larach M. Standardization of the caffeine halothane muscle contracture test. Anesth Analg. 1989;69:511–515
  34. Allen G, Fletcher J, Huggins F, et al. Caffeine and halothane contracture testing in swine using the recommendations of the North American malignant hyperthermia group. Anesthesiology. 1990;72:71–76
  35. Allen G, Rosenberg H, Fletcher J. Safety of general anesthesia in patients previously tested negative for malignant hyperthermia susceptibility. Anesthesiology. 1990;72:619–622
  36. Larach M, Landis J. False positive diagnosis of malignant hyperthermia susceptibility in control subjects using the North American caffeine halothane contracture test. Anesthesiology. 1990;73:A1013
  37. Allen G, Larach M, Kunselman A. The sensitivity and specificity of the caffeine-halothane contracture test: A report from the North American malignant hyperthermia registry. [clinical investigations] Anesthesiology. 1998;88:579–588
  38. Fletcher J, Rosenburg H, Aggarwal M. Comparison of European and North American malignant hyperthermia diagnostic protocol outcomes for use in genetic studies. Anesthesiology. 1999;90:654–661
  39. European MH Group . A protocol for the investigation of malignant hyperpyrexia. Br J Anaesth. 1984;56:1267–1269
  40. Islander G, Twetman E. Comparison between the European and North American protocols for diagnosis of malignant hyperthermia susceptibility in humans. Anesth Analag. 1999;88:1155–1160
  41. Malignant Hyperthermia Association of the United States. MH muscle biopsy centers (2007). Available at: http://medical.mhaus.org/index.cfm/fuseaction/Content.Display/PagePK/BiopsyTestCenters.cfm. Accessed January 29, 2008.
  42. The European Malignant Hyperthermia Group. MH Units (2007). Available at: http://www.emhg.org/index.php?option=com_content&;task=section&id=6&Itemid=54. Accessed January 28, 2008.
  43. Rosenberg H, Antognini J, Muldoon S. Testing for malignant hyperthermia. Anesthesiology. 2002;96:232–237
  44. Scala D, Martino D, Cozzolino S, et al. Follow-up of patients tested for malignant hyperthermia susceptibility. Eur J Anaesthesiol. 2006;23:801–805
  45. Larach M, Landis J, Bunn J, et al. Prediction of malignant hyperthermia susceptibility in low-risk subjects: An epidemiologic investigation of caffeine halothane contracture responses. Anesthesiology. 1992;76:16–27
  46. Ording H, Islander G, Bendixen D, et al. Between-center variability of results of the in vitro contracture test for malignant hyperthermia susceptibility. Anesth Analg. 2000;91:452–457
  47. Isaacs H, Badenhorst M. False-negative results with muscle caffeine halothane contracture testing for malignant hyperthermia. Anesthesiology. 1993;79:5–9
  48. Tegazzin V, Scutari E, Treves S, et al. Chlorocresol, an additive to commercial succinylcholine, induces contracture of human malignant hyperthermia-susceptible muscles via activation of the ryanodine receptor calcium sup 2+ channel. Anesthesiology. 1996;84:1380–1385
  49. Zorzato F, Scutari E, Tegazzin V, et al. Chlorocresol: An activator of ryanodine receptor-mediated Ca2+ release. Mol Pharmacol. 1993;44:1192–1201
  50. Wappler F, Scholz J, Fiege M, et al. 4-chloro-m-cresol is a trigger of malignant hyperthermia in susceptible swine. Anesthesiology. 1999;90:1733–1740
  51. Hollander A, Olney R, Blackett P, et al. Fatal malignant hyperthermia-like syndrome with rhabdomyolysis complicating the presentation of diabetes mellitus in adolescent males. Pediatrics. 2003;111:1447–1452
  52. Wappler F, Anetseder M, Baur C, et al. Multicentre evaluation of in vitro contracture testing with bolus administration of 4-chloro-m-cresol for diagnosis of malignant hyperthermia susceptibility. Eur J Anaesthesiol. 2003;20:528–536
  53. Baur C, Bellon L, Felleiter P, et al. A multicenter study of 4-chloro-m-cresol for diagnosing malignant hyperthermia susceptibility. Anesth Analg. 2000;90:200–205
  54. Jenden D, Haslett W. Ryanodine: A tool for the study of contraction mechanism in muscle. Proc Western Pharmacol Soc. 1960;3:44–52
  55. Fairhurst A, Jenden D. Effect of ryanodine on the calcium uptake system of skeletal muscle. Proc Nat Acad Sci U S A. 1962;48:807–813
  56. Hopkins P, Ellis F, Halsall P. Ryanodine contracture: A potentially specific in vitro diagnostic test for malignant hyperthermia. Br J Anaesth. 1991;66:611–613
  57. Hopkins P, Ellis F, Halsall P, et al. An analysis of the predictive probability of the in vitro contracture test for determining susceptibility to malignant hyperthermia. Anesth Analg. 1997;84:648–656
  58. Ginz H, Girard T, Censier K, et al. Similar susceptibility to halothane, caffeine and ryanodine in vitro reflects pharmacogenetic variability of malignant hyperthermia. Eur J Anaesthesiol. 2004;21:151–157
  59. Bendahan D, Guis S, Monnier N, et al. Comparative analysis of in vitro contracture tests with ryanodine and a combination of ryanodine with either halothane or caffeine: A comparative investigation in malignant hyperthermia. Acta Anaesthesiol Scand. 2004;48:1019–1027
  60. Reuter D, Anetseder M, Muller R, et al. The ryanodine contracture test may help diagnose susceptibility to malignant hyperthermia. Can J Anesth. 2003;50:643–648
  61. Fiege M, Wappler F, Weisshorn R, et al. Results of contracture tests with halothane, caffeine, and ryanodine depend on different malignant hyperthermia-associated ryanodine receptor gene mutations. Anesthesiology. 2002;97:345–350
  62. Pette D, Dolken G. Some aspects of regulation of enzyme levels in muscle energy-supplying metabolism. Adv Enzyme Reg. 1975;13:355–377
  63. Martin B, Valdivia H, Bunger R, et al. Pyruvate augments calcium transients and cell shortening in rat ventricular myocytes. Am J Physiol. 1998;274:H8–H17
  64. Anetseder M, Hager M, Muller C, et al. Diagnosis of susceptibility to malignant hyperthermia by use of a metabolic test. Lancet. 2002;359:1579–1580
  65. Schuster F, Scholl H, Hager M, et al. The dose-response relationship and regional distribution of lactate after intramuscular injection of halothane and caffeine in malignant hyperthermia-susceptibility pigs. Anesth Analg. 2006;102:468–472
  66. Schuster F, Metterlein T, Negele S, et al. Intramuscular injection of sevoflurane detects malignant hyperthermia predisposition in susceptible pigs. Anesthesiology. 2007;107:616–620
  67. Schuster F, Gardill A, Metterlein T, et al. A minimally invasive metabolic test with intramuscular injection of halothane 5 and 6 vol % to detect probands at risk for malignant hyperthermia. Anaesthesia. 2007;62:882–887
  68. Bina S, Cowan G, Karaian J, et al. Effects of caffeine, halothane, and 4-chloro-m-cresol on skeletal muscle lactate and pyruvate in malignant hyperthermia-susceptible and normal swine as assessed by microdialysis. Anesthesiology. 2006;104:90–100
  69. Sei Y, Gallaghert K, Basile A. Skeletal muscle type ryanodine receptor is involved in calcium signaling in human B lymphocytes. J Biol Chem. 1999;274:5995–6002
  70. Sei Y, Brandom B, Bina S, et al. Patients with malignant hyperthermia demonstrate an altered calcium control mechanism in B lymphocytes. Anesthesiology. 2002;95:1052–1058
  71. McCully K, Argov Z, Boden BB, et al. Detection of muscle injury in humans with 31P magnetic resonance spectroscopy. Muscle Nerve. 1988;2:212–216
  72. Olgin J, Argov Z, Rosenberg H, et al. Non-invasive evaluation of malignant hyperthermia susceptibility with phosphorus nuclear magnetic resonance spectroscopy. Anesthesiology. 1998;68:507–513
  73. Olgin J, Rosenberg H, Allen G, et al. A blinded comparison of noninvasive, in vivo phosphorus nuclear magenetic resonance spectroscopy and the in vitro halothane/caffeine contracture test in the evaluation of malignant hyperthermia susceptibility. Anesth Analag. 1991;72:36–47
  74. Payen J, Bosson J, Bourdon L, et al. Improved noninvasive diagnostic testing for malignant hyperthermia susceptibility from a combination of metabolites determined in vivo with 31P-magnetic resonance spectroscopy. Anesthesiology. 1993;78:848–855
  75. Bendahan D, Kozak-Ribbens G, Rodet L, et al. Sup 31 phosphorus magnetic resonance spectroscopy characterization of muscular metabolid anomalies in patients with malignant hyperthermia: Application to diagnosis. Anesthesiology. 1998;88:96–107
  76. Fill M, Coronado R, Mickelson J, et al. Abnormal ryanidine receptor channels in malignant hyperthermia. Biophys J. 1990;57:471–475
  77. MacLennan D, Duff C, Zorzato F, et al. Ryanodine receptor gene is a candidate for predisposition to malignant hyperthermia. Nature. 1990;343:559–561
  78. McCarthyT Healy J, Heffron J, et al. Localization of the malignant susceptibility locus to human chromosome 19q12-13.2. Nature. 1990;343:562–564
  79. Phillips M, Fujii J, Khanna V, et al. The structural organization of the human skeletal muscle ryanodine receptor (RyR1) gene. Genomics. 1996;34:24–41
  80. Litman R, Rosenberg H. Malignant hyperthermia: Update on susceptibility testing. JAMA. 2005;293:2918–2924
  81. McCarthy T, Quane K, Lynch P. Ryanodine receptor mutations in malignant hyperthermia and central core disease. Human Mutat. 2000;15:410–417
  82. Ruffert H, Olthoff D, Deutrich C, et al. Mutation screening in the ryanodine receptor 1 gene (RyR1) in patients susceptible to malignant hyperthermia who show definite IVCT results: Identification of three novel mutations. Acta Anaesthesiol Scand. 2002;46:692–698
  83. Sei Y, Sambuughin N, Davis E, et al. Malignant hyperthermia in North America: Genetic screening of the three hot spots in the type I ryanodine receptor gene. Anesthesiology. 2004;101:824–830
  84. MacKenzie A, Allen G, Lahey D, et al. A comparison of the caffeine halothane muscle contracture test with the molecular genetic diagnosis of malignant hyperthermia. Anesthesiology. 1991;75:4–8
  85. Lynch P, Krivosic-Horber R, Reyford H, et al. Identification of heterozygous and homozygous individuals with the novel RyR1 mutation Cys35Arg in a large kindred. Anesthesiology. 1997;86:620–626
  86. Deufel T, Dobler M, Hackl W, et al. Malignant hyperthermia susceptibility (MH): Prevalence of the mutation R614C in the ryanodine receptor gene on chromosome 19q13.1 in German and Austrian MH families. Am J Human Genet. 1992;51(Suppl):A213
  87. Deufel T, Sudbrak R, Feist Y, et al. Discordance in a malignant hyperthermia pedigree, between in vitro contracture-test phenotypes and haplotypes for the MHS 1 region on chromosome 19q12-13.3 comprising the C1840T transition in the RyR1 gene. Am J Human Genet. 2001;56:1334–1342
  88. Gillard E, Otsu K, Fujii J, et al. A substitution of cysteine for arginine 614 in the ryanodine receptor is potentially causative of human malignant hyperthermia. Genomics. 1991;11:751–755
  89. Brandt A, Schleithoff L, Jurkat-Rott K, et al. Screening of the ryanodine receptor gene in 105 malignant hyperthermia families: Novel mutations and concordance with the in vitro contracture test. Human Mol Genet. 1999;8:2055–2062
  90. Brown R, Pollock AN, Couchman K, et al. A novel ryanodine receptor mutation and genotype-phenotype correlation in a large malignant hyperthermia New Zealand Maori pedigree. Human Mol Genet. 2000;9:1515–1524
  91. Sambuughin N, Sei Y, Gallagher K, et al. North American malignant hyperthermia population: Screening of the ryanodine receptor gene and identification of novel mutation. Anesthesiology. 2001;95:594–599
  92. Girard T, Urwyler A, Censier K, et al. Genotype-phenotype comparison of the Swiss malignant hyperthermia population. Human Mutat. 2001;18:357–358
  93. Robinson R, Brooks C, Brown S, et al. RyR1 mutations causing central core disease are associated with more severe malignant hyperthermia in vitro contracture test phenotypes. Human Mutat. 2002;20:88–97
  94. Robinson R, Anetseder M, Brancadoro V, et al. Recent advances in the diagnosis of malignant hyperthermia susceptibility: How confident can we be of genetic testing?. Eur J Human Genet. 2003;11:342–348
  95. McWilliams S, Nelson T, Sudo R, et al. Novel skeletal muscle ryanodine receptor mutation in a large Brazilian family with malignant hyperthermia. Clin Genet. 2002;62:80–83
  96. Punj J, Bhatnagar S, Saxena A. Malignant hyperthermia in the Indian subcontinent: Non-availability of dantrolene—A cause for concern?. Internet J Anesthesiol. 2001;5:Available at http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijpharm/vol1n1/mh.xml. Accessed January 10, 2008
  97. Xu Z, Luo A, Guo X, et al. Malignant hyperthermia in China. Anesth Analg. 2005;103:983–985
  98. Olckers A, Meyers D, Meyers S, et al. Adult muscle sodium channel alpha-subunit is a gene candidate for malignant hyperthermia susceptibility. Genomics. 1992;14:829–831
  99. Levitt R, Olckers A, Meyers S, et al. Evidence for the localization of a malignant hyperthermia susceptibility locus (MHS2) to human chromosome 17q. Genomics. 1992;14:562–566
  100. Iles D, Lehmann-Horn F, Scherer S, et al. Localization of the gene encoding the alpha2/delta-subunits of the L-type voltage-dependent calcium channel to chromosome 7q and analysis of the segregation of flanking markers in malignant hyperthermia susceptible families. Human Mol Genet. 1994;3:969–975
  101. Sudbrak R, Procaccio V, Klausnitzer M, et al. Mapping a further malignant hyperthermia locus to chromosome 3q13.1. Am J Human Genet. 1995;56:684–691
  102. Gregg R, Couch F, Hogan F, et al. Assignment of the human gene for the alpha1 subunit of the skeletal muscle DHP-sensitive Ca2+ channel (CACNL1A3) to chromosome 1q31-q32. Genomics. 1993;15:107–112
  103. Stewart S, Hogan K, Rosenberg H, et al. Identification of the Arg1086His mutation in the alpha subunit of the voltage-dependent calcium channel (CACNA1S) in a North American family with malignant hyperthermia. Clin Genet. 2001;59:178–184
  104. Robinson R, Monnier N, Wolz W, et al. A genome wide search for susceptibility loci in three European malignant hyperthermia pedigree. Human Mol Genet. 1997;6:953–961
  105. Robinson R, Curran J, Ellis F, et al. Multiple interacting gene products may influence susceptibility to malignant hyperthermia. Ann Human Genet. 2000;64:307–320
  106. Ibarra C, Wu S, Murayama K, et al. Malignant hyperthermia in Japan: Mutation screening of the entire ryanodine receptor type 1 gene coding region by direct sequencing. Anesthesiology. 2006;104:1146–1154
  107. Monnier N, Krivosic-Horber R, Payen J, et al. Presence of two different genetic traits in a malignant hyperthermia families: Implications for genetic analysis, diagnosis, and incidence of malignant hyperthermia susceptibility. Anesthesiology. 2002;97:1067–1074
  108. Ording H. Investigation of malignant hyperthermia susceptibility in Denmark. Danish Med Bull. 1996;43:111–125
  109. Robinson R, Carpenter D, Shaw M, et al. Mutations in RyR1 in malignant hyperthermia and central core disease. Human Mutat. 2006;27:977–989
  110. Wu S, Ibarra M, Malicdan M, et al. Central core disease is due to RyR1 mutations in more than 90% of patients. Brain. 2006;129:1470–1480
  111. Monnier N, Ferreiro A, Marty I, et al. A homozygous splicing mutation causing a depletion of skeletal muscle RYR1 is associated with muli-minicore disease congenital myopathy with opthalmoplegia. Human Mol Genet. 2003;12:1171–1178
  112. Koch B, Bertorini T, Eng G, et al. Severe multicore disease associated with reaction to anesthesia. Arch Neurol. 1985;42:1204–1206
  113. Osada H, Masuda K, Seki K, et al. Multi-minicore disease with susceptibility to malignant hyperthermia in pregnancy. Gynecol Obstet Invest. 2004;58:32–35
  114. Flick R, Gleich S, Herr M, et al. The risk of malignant hyperthermia in children undergoing muscle biopsy for suspected neuromuscular disorder. Pediatr Anesth. 2007;17:22–27
  115. Harrison G. Control of the malignant hyperpyrexic syndrome in MHS swine by dantrolene sodium. Br J Anaesth. 1975;47:62–65
  116. Kolb M, Horne M, Martz R. Dantrolene in human malignant hyperthermia. Anesthesiology. 1982;56:254–262
  117. Krause T, Bergershagen M, Fiege M, et al. Dantrolene - a review of its pharmacology, therapeutic use and new developments. Anesthesia. 2004;59:364–373
  118. Ward A, Chaffman M, Sorkin E. Dantrolene: A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. Drugs. 1986;32:130–168
  119. Baker K, Landriscina D, Kartchner H, et al. The Icarus effect: The influence of diluent warming on dantrolene sodium mixing time. AANA J. 2007;75:101–106
  120. Brandom B, Larach M. North American Malignant Hyperthermia Registry. Reassessment of the safety and efficacy of dantrolene. ASA Annual Meeting Abstracts. 2002;A1199
  121. Fletcher J, Lizzo F, Rosenberg H. Azumolene, a new dantrolene analogue, antagonizes halothane and caffeine contractures: Potential for use in malignant hyperthermia. Anesthesiology. 1988;69:A419
  122. Dershwitz M, Sreter F. Azumolene reverses episodes of malignant hyperthermia in susceptible swine. Anesth Analg. 1990;70:253–255
  123. el-Hayek R, Parness J, Valdivia H, et al. Dantrolene and azumolene inhibit [3H]PN200-110 binding to porcine skeletal muscle dihidropyridine receptors. Biochem Biophys Res Commun. 1992;187:894–900
  124. Zhao X, Weisleder N, Han X, et al. Azumolene inhibits a component of store-operated calcium entry coupled to the skeletal muscle ryanodine receptor. J Biol Chem. 2006;281:33477–33486
  125. Sudo R, Carmo P, Trachez M, et al. Effects of azumolene on normal and malignant hyperthermia-susceptible skeletal muscle. Basic Clin Pharmacol Toxicol. 2008;102:308–316
  126. Foster P, Hopkinson K, Payne N, et al. The effect of azumolene on hypercontractility and sarcoplasmic reticulum Ca2+ dependent ATPase activity of malignant hyperpyrexia-susceptible porcine skeletal muscle. Clin Exp Pharmacol Physiol. 1991;18:489–495

PII: S1089-9472(08)00344-4

doi: 10.1016/j.jopan.2008.12.001

Journal of PeriAnesthesia Nursing
Volume 24, Issue 1 , Pages 19-34 , February 2009